NCG080583_2020 DMR_20210119 (7)

NCDEQ Dit
sion of Energy, Mineral and Land Resources
Stormwater Discha
ge Monitoring Report (DMR) Form for NCG080000
Transit and Transportation
Click here for instructions
Complete, sign, scan and submit the DMR vi
the Stormwater NPDES Permit Data Monitoring Report
DMR) Upload form within
e original, signed hard copy of the DMR to the a iDpropriate DEMLR Regional Office.
Person Collecting Samples: T Ltrr�l
30 days of receiving sampling results. Mail t
Certificate of Coverage No. NCG08 Q S $ 3
Facility Name: 6c,1►^e,Ar
Laboratory Name: ('c•ce A►c.ty-E%ca
Facility County:
Laboratory Cert. No.: 3720
Discharge during this period: ❑ Yes ®-No (i
no, skip to signature and date)
Has your facility implemented mandatory Tier tesponse
actions for any benchmark exceedances?
KYes ❑ No
If so, which Tier (I, II, or III)? 1
Part A: Vehicle & Equipment Maintenance Areas
— Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall i'
Outfall
O:utfahl' .:
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in mg/L (100 or 50')
00400
pH in standard units (6.0-9.0)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Part B: Oil/Water Separators & Secondary Cor
Parameter
Parameter..
Outfall
Outfall
Outfall
Otdall:
Outfall,-
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in mg/L (100 or 50")
High Quality Waters (HOW), Trout Waters (Tr) and Pri:r)M Nursery Areas (PNA)
00400
pH in standard units (6.0-9.0)
" Outfalls to Outstanding Resource Waters (ORW)
have a benchmark TSS limit of 50 mg/L. All other
water classifications have a benchmark of 100 mg/L
T
of law, that this document and all attachments were prepared under my direction or
Notes (optional): o 0r- 7 O ;?-O
"I certify by my signature below, under penalty
supervision in accordance with a system desigr
ed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person c
r persons who manage the system, or those persons directly responsible for
gathering the information, the information sub
itted is, to the best of my knowledge and belief, t.rue, accurate, and complete. I am
aware that there are significant penalties for sL
bmitting false information, including the possibility of fines and imprisonment for
knowing violation
�
1 /?,1 2 I
d Individual b ate
,Signature of ermittee or Delegated Authoriz4